Corticosteroid or Nonsteroidal Antiinflammatory Drugs for the Treatment of Acute Gout: A Systematic Review of Randomized Controlled Trials.

From the University of Sydney, Sydney, Australia; Diaverum Medical Scientific Office and Diaverum Academy, Lund, Sweden; Amedeo Avogadro University of Eastern Piedmont, Novara; University of Bari, Bari, Italy; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.

From the University of Sydney, Sydney, Australia; Diaverum Medical Scientific Office and Diaverum Academy, Lund, Sweden; Amedeo Avogadro University of Eastern Piedmont, Novara; University of Bari, Bari, Italy; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand. gfmstrippoli@gmail.com.

RESULTS:

Six eligible trials (817 patients) were identified. The mean study followup was 15 days (range 4-30). Risks of bias were generally low. In low- to moderate-quality evidence, corticosteroids did not have different effects on pain score at < 7 days [standardized mean difference (SMD) -0.09, 95% CI -0.26 to 0.08] or at ≥ 7 days (SMD 0.32, 95% CI -0.27 to 0.92) when compared with NSAID. There was no evidence of different risks of gastrointestinal bleeding [relative risk (RR) 0.09, 95% CI 0.01-1.67]. There was no evidence of different responses to therapy on pain at < 7 days (RR 1.07, 95% CI 0.80-1.44) and ≥ 7 days, time to disease resolution, or number of supplementary analgesics used (MD 2.10 drugs, 95% CI -1.01 to 5.21). There was a lower risk of indigestion (RR 0.50, 95% CI 0.27-0.92), nausea (RR 0.25, 95% CI 0.11-0.54), and vomiting (RR 0.11, 95% CI 0.02-0.56) with corticosteroid therapy.

CONCLUSION:

There is no evidence that corticosteroids and NSAID have different efficacy in managing pain in acute gout, but corticosteroids appear to have a more favorable safety profile for selected adverse events analyzed in existing RCT.